Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
NIHR Greater Manchester Patient Safety Research Collaboration, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
PLoS One. 2024 Sep 13;19(9):e0308638. doi: 10.1371/journal.pone.0308638. eCollection 2024.
Identifying women aged 30-39 years at increased risk of developing breast cancer would allow them to receive screening and prevention offers. For this to be feasible, the practicalities of organising risk assessment and primary prevention must be acceptable to the healthcare professionals who would be responsible for delivery. It has been proposed that primary care providers are best placed to deliver a breast cancer risk assessment and primary prevention pathway. The present study aimed to investigate a range of primary care provider's views on the development and implementation of a breast cancer risk assessment and primary prevention pathway within primary care for women aged 30-39 years.
Twenty-five primary care providers working at general practices in either Greater Manchester or Cambridgeshire and Peterborough participated in five focus groups (n = 18) and seven individual interviews. Data were analysed thematically and organised using a framework approach.
Three themes were developed. Challenges with delivering a breast cancer risk assessment and primary prevention pathway within primary care highlights that primary care are willing to facilitate but not lead delivery of such a pathway given the challenges with existing workload pressures and concerns about ensuring effective clinical governance. Primary care's preferred level of involvement describes the aspects of the pathway participants thought primary care could be involved in, namely co-ordinating data collection for risk assessment and calculating and communicating risk. Requirements for primary care involvement captures the need to provide a training and education package to address deficits in knowledge prior to involvement. Additionally, the reservations primary care have about being involved in the management of women identified as being at increased risk are discussed and suggestions are provided for facilitating primary care to take on this role.
Despite optimism that primary care might lead a breast cancer risk assessment and primary prevention pathway, participants had a range of concerns that should be considered when developing such a pathway.
识别出 30-39 岁年龄段有较高患乳腺癌风险的女性，使她们能够获得筛查和预防服务。为了实现这一目标，负责实施的医疗保健专业人员必须能够接受组织风险评估和初级预防的实际操作。有人提议，初级保健提供者最适合提供乳腺癌风险评估和初级预防途径。本研究旨在调查一系列初级保健提供者对在 30-39 岁女性的初级保健中制定和实施乳腺癌风险评估和初级预防途径的看法。
在大曼彻斯特或剑桥和彼得伯勒的全科医生诊所工作的 25 名初级保健提供者参加了 5 个焦点小组（n=18）和 7 个单独访谈。使用主题分析法对数据进行分析，并使用框架方法进行组织。
得出了 3 个主题。在初级保健中提供乳腺癌风险评估和初级预防途径的挑战突显了初级保健提供者愿意促进但不愿意主导该途径的实施，因为他们面临着现有工作量压力的挑战以及对确保有效临床治理的担忧。初级保健的首选参与程度描述了参与者认为初级保健可以参与的途径的各个方面，即协调风险评估的数据收集、计算和沟通风险。初级保健参与的要求捕捉到了在参与之前提供培训和教育包以解决知识缺陷的需求。此外，还讨论了初级保健对参与管理被确定为高风险的女性所保留的意见，并提供了促进初级保健承担这一角色的建议。
尽管对初级保健可能引领乳腺癌风险评估和初级预防途径持乐观态度，但参与者有一系列关注，在制定此类途径时应予以考虑。
